HIV and ID Observations

October 27th, 2008

Antibiotics as Placebos?

This article in the BMJ is geting lots of news:  Out of 679 practicing physicians in the United States, about half admitted to prescribing placebos on a regular basis.  A “small but notable proportion (13%) of physicians reported using antibiotics.” My first instinct was surprise that the rate was this low, but then I remembered that public […]

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October 21st, 2008

Back to School, Day 4: PEP and More PEP

After a lecture on HIV for Primary Care Providers in our course last week, the most controversial topic was, not surprisingly, the use of post-exposure prophylaxis (PEP) for both occupational and non-occupational exposures.  And today, after an entire lecture on PEP to a group of HIV providers in our AIDS course, again the subject drew […]

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October 18th, 2008

Back to School, Day 2

During the course, often the best questions and anecdotes come during the breaks.  Here are a few: Tons of questions about our favorite nemesis, MRSA.  What works for chronic carriers?  How do you manage family members who you suspect would be culture-positive (and the source of recurrences), but are not your patient?  What if the vet […]

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October 1st, 2008

Deadlines of Note

Just a reminder of some interesting deadlines/events out there, in case you were too wrapped up sharpening pencils for tomorrow’s Vice Presidential debate: As of today, Medicare will no longer reimburse hospitals for medical errors — which includes some hospital-acquired infections.  According to this article, several other payors (including private insurers) are using this as a precedent […]

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September 29th, 2008

Required Reading: The Value of ID Specialists

In the most recent issue of Clinical Infectious Diseases, there’s a comprehensive review of the value of an ID specialist from the perspective of non-patient care activities.  Covered in particular are: Antibiotic stewardship Infection control Monitoring rates of nosocomial infections Managing health care worker “well-being and exposures” Also included are tables listing dozens of studies quantifying the value […]

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September 18th, 2008

C. diff: The cure for antibiotic abuse

Even with market doom-and-gloom dominating the news, there’s a good article in yesterday’s Wall Street Journal on Clostridium difficile (C. diff).  It gives an accurate summary (in lay language) of the problem, several pertinent clinical anecdotes, and quotations from national experts. But this part in particular caught my eye: She says that among other measures, the hospital has […]

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September 10th, 2008

Yes, TNF blockers increase infection risk. Now what?

So the FDA has issued (another) warning about TNF (tumor necrosis factor) blockers and increased infection risk, this time focusing on fungal infections, in particular histoplasmosis.  TNF blockers are used for treatment of rheumatoid arthritis, Crohn’s Disease, ankylosing spondylitis, psoriasis, and a wide range of other autoimmune diseases, both in approved and in off-label use. ID/HIV specialists […]

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August 22nd, 2008

We have met the enemy … and it is MRSA

In Jerry Groopman’s recent New Yorker piece on antibiotic-resistant bacteria, he quotes Dr. Louis Rice from the Cleveland VA, who uses the term “ESKAPE” bacteria:  an acronym for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, and Enterobacter. Nothing against the mostly gram-negative nasties in this list (and the focus of the New Yorker article), […]

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August 8th, 2008

More from Mexico City

A bit more travelogue from the XVII International AIDS Conference: It’s impossible to see everything you want at such a large, sprawling conference, sometimes because of conflicting meetings, sometimes because the room is full, sometimes because of a feeling analagous to being in a giant museum for too many hours — fatigue just takes over.  But I’m […]

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July 29th, 2008

Antiretroviral Rounds: Immediate ART After an OI — Are We There Yet?

A few things have been guaranteed to get widely divergent views among HIV specialists — and one of them was when to start antiretroviral therapy in someone presenting with an acute OI.  However, in the latest Antiretroviral Rounds, our two experts (Raphy Landovitz and Phil Grant/Andrew Zolopa) kind of agreed.  They’d start immediately.    At least that’s […]

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